L 75 Not everything that scales is fungus

Question 1

Tinea Versicolor

Pityriasis

Answer 1

Hyper or Hypo pigmented patches of skin lesions that fluoresce under black light, tend to be on upper back of young adults.
Bug is M. globosa or M. furfur both are normal flora
Common in warm and humid climates
Spaghetti and meatball hyphal pattern, observed with KOH
Treated with slenium sulfide or ketoconazole shampoo/wash

Question 2

Tinea Pedis

Answer 2

3 Varieties:
1) Hyperkeratotic (moccasin): most difficult to treatment, T. rubrum, use creams for 4 weeks or oral for 1-2 weeks, rarely in between the toes

2) Intertriginous: antifungal gels or sprays X 4 weeks, if white or dark colored might need antibacterial treatment, gentian violet works well to dry and kill, or castellani’s paint, keep feet dry
3) Vesiculobullous (least common) has blisters, T. mentagrophytes, vesicles by immune reaction, often on non-weight-bearing surfaces, topical antifungal works

A fungal infection of the skin
Diagnosed by KOH, or DTM (dermatophyte test medium)

Question 3

Tinea Manuum

Answer 3

Often unilateral

Similar to corporis–annular lesions

Question 4

Tinea Cruris

Answer 4

Groin/buttock

Lotions or oral

Question 5

Tinea Corporis

Answer 5

Annular lesions
Often require oral antifungals
Occasionally pustular lesions

Question 6

Tinea Capitis

Answer 6

Kids more likely

Diffuse scaling and alopecia

Question 7

Tinea Barbae

Answer 7

Beard dermatophyte infection

Invades hair follicles => inflammation

Question 8

Tinea Nigra

Answer 8

Not dermatophyte infection
Caused by Hortaea
Pigmented scaly lesions
Topical antifungals and kertolytics

Question 9

Majocchi Granuloma

Answer 9

Commonly lower legs of young women
Deeper invasion than other dermatophyte infections
Granulomatous papules with inflammation and scaling
Will not respond to topical anti-fungals, oral for 4-6 weeks

Question 10

Two foot, one hand

Answer 10

Scale without inflammation
Nail involvement on one hand is pathopneumonic
Oral antifungal required

Question 11

Candidiasis

Answer 11

Most commonly in kids (oral thrush)
Immune deficiency common
White creamy papules on mucosa
Must keep the skin dry–a barrier to the skin may be needed to prevent moisture
Topical and oral antifungals needed

Question 12

Mucocutaneous Candidiasis

Answer 12

Primary immune deficiency syndrome
Recurring infections around nails
Onset in early childhood
Can spread to the lungs

Question 13

What is the classic sign on nails for Psoriasis?

Answer 13

Pitting and oil drop

Question 14

Methods to diagnose fungal nail infections

Answer 14

KOH
DTM
PAS Stain
Fungal Cultures
PCR
(only last two will give specific organism)

Question 15

Nail fungal treatments

Answer 15

Efinaconazole (Jublia)
Tavaborole (Kerydin)

Tea Tree Oil
Funginail
Mycoside

Systemic:
Terbinafine
Itraconazole
Fluconazole
Griseofulvin (only one for kids)